181044 01/12/2010 CITY OF CARMEL, INDIANA VENDOR: 069001 Page 1 of 1
a ONE CIVIC SQUARE CRYSTAL FLASH PETROLEUM CHECK AMOUNT: $77.00
t., CARMEL, INDIANA 46032 PO BOX 105080
te o; o ATLANTA GA 30348 -5080 CHECK NUMBER: 181044
CHECK DATE: 1/12/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 BG1298219 77.00 BG1298219
2673101 zolooloolso■ 00119
1
CRYSTAL /FLA.57-1 Local Office: Crystal Flash Petroleum PL
PO BOX 105080 For billing questions call: (800) 903 -9368
ATLANTA, GA 30348 -5080
Account BG1298219
Please reference account on all payments
111111111111111111111111111111 119 STATEMENT# NP22799958
DATE 01/01/2010
CITY OF CARMEL ITILITIES DUE DATE 01/31/2010
1 CIVIC SQ TOTAL BALANCE DUE $77.00
CARMEL IN 46032 -2584
PAYMENT TERMS Net 30 MN
For online statements and simple, automated payment setup, contact customer service at cardservices @fleetcor.com.
DESCRIPTION OF CURRENT ACTIVITIES
Services and Fees as reported 12/31/2009
Date Description Gallons Amount Due
01/01/2010 Fleet 1315591 Name: CITY OF CARMEL- UTILITIES 30.089 $77.00
Current Activity
Previous
Statement Prior Balance Payments and Gallons Charges Total Balance Due
Date Adjustments
12/01/2009 $0.00 $0.00 30.089 $77.00 $77.00
FOR PROPER PAYMENT POSTING, PLEASE-`" YOUR CHECK WITH ONLY THE REMITTANCE COPY BELOW.
2,:1)101 2hI,,001fnl'f 1401 Ont 14
CRV YAL7FLAEH..
PO BOX 105080 FLEET MANAGEMENT REPORT
ATLANTA, GA 30348 -5080 Account BG1298219
FLEET 1315591
Provided By: Name: CITY OF CARMEL- UTILITIES
Crystal Flash Petroleum PL
(800) 903 9368 MATCHING STATEMENT NP22799958
Page: 1 of 1
CITY OF CARMEL ITILITIES
1 CIVIC SQ
CARMEL IN 46032
FLEET MANAGEMENT REPORT FOR 12/1/2009 12/31/2009
SUMMARY OF TRANSACTIONS THIS REPORTING PERIOD FOR ALL VEHICLES IN YOUR FLEET
PRODUCT QUANTITY BASE PRICE FEDERAL STATE OTHER TOTAL
UNL 30.089 $61.36 $5.60 $10.04 $0.00 $77.00
r 71 `"a 8 sue-
Total I l 30.089 $61 36 $5 60 10 04� $0 00 1 '$77 00
This report is for information only.
Please see remittance copy on the statement for the total payment amount.
TOTAL MILES: 0
Transaction Detail for Customer NQ 1315591 CITY OF- CARMEL ITILITIES 12/1/2009' 12/31/2009 k y 1�
FUEL NET TOTAL EXCEPT
DATE TIME SITE DRIVER ODOMETER MPG TYPE QTY PRICE TAXES AMT CODE**
5671 2007 FORD F2 24 a 7 w. .w.,.
12/17 11:46 885419 DRIVER 1 28947 0.0 UNL 30.089 2.03930 0.51947 $77.00
Miles: 30.089 $77.00
SITE LEGEND
SITE SITE NAME ADDRESS CITY STATE
885419 Crystal Flash #67 545 S Rangeline Rd Carmel IN
VOUCHER 097081 WARRANT ALLOWED
69001 IN SUM OF
CRYSTAL FLASH
PETROLEUM CORPORATION
PO BOX -684 10508'v A114,0 6P
6 3
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
BG1298219 011500 -08 $77.00
Voucher Total $77.00
Cost distribution ledger classification if
claim paid under vehicle highway fu
-0°C\
Prescribed by State Board of Accounts City Form No. 201 (Rev 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or bill to be properly itemized must show, kind of service, where
performed, dates of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
69001
CRYSTAL FLASH Purchase Order No.
PETROLEUM CORPORATION Terms
PO BOX 684 Due Date 12/30/2009
INDIANAPOLIS, IN 46206
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
12/30/200 BG1298219 $77.00
1 hereby certify that the attached invoice(s), or bill(s) is (are) true and
correct and I have audited same in accordance with IC 5- 11- 10 -1.6
k
Date Officer